Is it plagiocephaly?

What to look for and what to do to treat it

Maayan S. Heller

9/1/09 10:22 AM

Short stuff: Health roundupNewborns’ soft skulls can be misshapen in childbirth, which usually resolves on its own within the first month or so. But some babies develop positional plagiocephaly, a condition often caused by sleeping on one side only, in which a flat spot on the head develops.

If recognized early and treated, positional plagiocephaly can be corrected. In fact, says Dr. David M. Frim, associate professor of surgery and pediatrics and chief of neurosurgery at the University of Chicago, "it’s preventable."

"Babies were designed to sleep on their bellies," he says. "The bones on the face and the front of the skull are less mobile than on the back of the skull."

Reports of growing numbers of SIDS (Sudden Infant Death Syndrome) cases worldwide in the late ’80s and early ’90s led to an American Academy of Pediatrics recommendation that babies sleep on their backs.

"This only lasts until kids can roll over, then they end up on their bellies anyway," Frim says.

The "Back to Sleep" campaign launched in 1992 in response to rising SIDS numbers likely saved thousands of lives, but the timeline also coincides with a five-fold increase in babies with positional plagiocephaly.

He says you should switch the sleeping side (at night, not necessarily for daytime naps) day by day: "So on Sunday, she goes down on her belly, Monday night she’s on her right side, Tuesday night she’s on her back, Wednesday night on her left side and by Thursday she’s back on her belly."

It’s critical to start this process or recognize a flatter side early.

"We find that after the point when the soft spot closes (around 12-16 months) there’s no more moldability [of the skull]," Frim says. The brain doubles in size from 2 to 3 months to 12 months and then only 10 percent more by age 2.

"The closer you get to the 12-month mark, or to when the soft spot closes, the more difficult remolding the head will be. You’re more likely to get stuck with it."

If it’s caught early, try to correct it with positioning treatment, such as Frim’s "Sleep Around" rotation.

He suggests keeping your baby on her belly when awake and at night track how she’s sleeping to help her head grow round.

In some cases positioning might not work and helmets can be used to provide a round surface for babies’ heads to grow into.

"Helmeting is very effective," Frim says. Babies wear helmets for about 23 hours a day until the soft spot closes. Helmeting should only be done under a physician or neurosurgeon’s observation.

If you’re concerned about the symmetry of your baby’s head, consult your pediatrician or see a neurosurgeon. They’ll let you know treatment is needed.

Though rare, if never treated, positional plagiocephaly can cause problems with head, skull, jaw or neck bones development and may need surgical treatment later.

But Frim emphasizes parents should know this condition it won’t affect brain development or cause children to be delayed.

"The key is simple," Frim says. "It’s just figuring out that it’s there."